Norovirus

I don’t talk about norovirus much on the pages of my blog despite the fact that norovirus is estimated to cause 23 million cases of acute gastroenteritis (commonly called the "stomach flu") in the U.S. each year, and are the leading cause of gastroenteritis. Of viruses, only the common cold is reported more often than viral gastroenteritis (norovirus). Norovirus may cause more outbreaks of foodborne illness than all bacteria and parasites. They can cause extended outbreaks because of their high infectivity, persistence in the environment, resistance to common disinfectants, and difficulty in controlling their transmission through routine sanitary measures. I was therefore glad to see the Orlando Sentinel’s report on "83 guests suffer norovirus outbreak at Palm Beach resort."

Florida Health officials identified the highly contagious norovirus as the cause of an outbreak that sickened at least 83 people at the Hilton Singer Island Resort. Health officials were called in after three people were hospitalized. Test results confirm that the outbreak was norovirus, a highly contagious virus that causes diarrhea, vomiting, nausea, cramps and other symptoms, officials said.

"It spreads easily and quickly," said Tim O’Connor, spokesman for the Palm Beach County Health Department. "We’ve asked (the hotel) to completely disinfect everything." The hotel shut down its kitchen Saturday, threw out food and cleaned, so health officials are unable to determine whether the virus outbreak began in the restaurant. "We didn’t know what we were looking at," said hotel manager Stan Turner. "If it is food-borne, you know that it’s this plate, this salad. But if it’s norovirus, it comes from everywhere, so that’s unnerving. "The hotel restaurant reopened after staff cleaned the entire property, Turner said. "It has been a floor-by-floor, room-by-room, surface-by-surface process," he said. "We are not resting. We are still cleaning." The hotel restaurant was cited for more than a dozen violations during a December state inspection, but the report noted there was no "immediate threat to the public."

We have taken on several hundred cases of norovirus-caused illnesses over the years. However, showing how the virus is transmitted is hard. Was it foodborne? Was it an ill worker? Ill patron?

1. Stay at home and away from others if you are ill, and for at least two days after you start feeling better. Food workers should stay home 72 hours.

2. Wash hands thoroughly with soap and water. “Sing happy birthday,” one expert said. “That’s about how long you should scrub.” Alcohol-based sanitizers are not effective against norovirus.

3. Clean all possibly contaminated surfaces with a chlorine bleach solution. Use 1/3 cup of bleach in 1 gallon of water for non-porous surfaces (toilets, sinks, countertops). Use 1 2/3 cups of bleach in 1 gallon of water for wooden floors and other surfaces that could absorb vomit splatters.

And, it even ruins weddings – Iowa Couple Sues Restaurant After Rehearsal Dinner Sickens Wedding Party – A central Iowa couple is suing the restaurant where they held their rehearsal dinner the night before their November 2006 wedding. A Polk County Health Department investigation concluded the man who prepared the salad served at dinner that night had stomach flu. The official cause was determined to be norovirus. A total of 71 people became sick. Restaurant owner Paul Trostel said his insurance company has settled with many of the customers who fell ill.

"I feel very terrible about this situation that happened once in 20 years," he said. "It could have happened to any restaurant, but unfortunately it happened at the Greenbriar."

When Taco Bell offered free tacos for every American during baseball’s World Series last month, all I could do was hold my head and mutter something like: "Hasta luego, Amigos!"

The very idea of doling out fast-food tacos to millions of baseball fans should ring like a casino jackpot jingle in the corridors of a personal injury law firm like mine – or all the "wannabees" that are beginning to light up the Internet with "google ads" and plagiarized blogs. Recently tacos seem have a food-poisoning track record right up there with Chinese-manufactured pet food. In the past few years alone, we’ve seen outbreaks of deadly E. coli O157:H7, Salmonella, Hepatitis A, Listeria, Shigella and Norovirus in at least 13 states, from Washington and California to New York and Texas – all traced to restaurant tacos.

Just this year there have been taco-related outbreaks in Alabama, Illinois and Oregon. And those are just the outbreaks scientifically traced by public health officials. We’ll never know how many more people have been sickened without identifying a source. Tracing the source of disease outbreaks isn’t easy. Health officials need to detect an outbreak early, thoroughly interview sick people and find the common denominator before memories fade and evidence disappears.

And even when tacos are suspect, the specific source of the poison varies from one outbreak to the next. In the Alabama outbreak last summer, the culprit may have been lettuce laced with E. coli. In Illinois, it was Salmonella in the cheese. An outbreak at Taco Bell last year in East Coast states was blamed on tainted lettuce, or as my post below says – maybe not. Others have been tracked back to green onions, cilantro or undercooked meat. It seems that when restaurants layer tortillas, meat, cheese, tomatoes, onions, avocado and lettuce, there are multiple opportunities to contaminate, cross-contaminate and make people sick.

Take, for example, a major outbreak of Hepatitis A in Florida in December, 2000. Officials at the Lake County Health Department learned that seven people were sick, and five were hospitalized with Hepatitis A, all in a two-week span. State and local officials identified the toxin and questioned each of the patients, including family members and friends who were not so sick. Eventually, officials identified 78 people sickened in five eastern states. In the Florida case, most of the sick people had eaten at a Taco Bell restaurant in Fruitland Park. Further inquiry narrowed the possibilities down to six menu items and eight ingredients, and only two of those items had been eaten by a majority of the sick people. Eventually, they zeroed in on the green onions as the most likely cause. But, given the fact that nearly every menu item in a Taco Bell has nearly the same ingredients, how do you really know what ingredient was contaminated?

My point: Tacos can be dangerous. The ingredients – meat and lettuce and green onions – come from an array of sources, are handled by so many people and are all tossed into the same products, creating a very muddy trail of evidence. A list of outbreaks below:

And there have been more – In October 2007, Tortilla Flat was the scene of a Norovirus outbreak and just a few days ago, Carniceria Y Taqueria served Salmonella-Tainted Tacos in North Carolina. Buenos Noches. Thanks to my friends at K-State (who bring you BARFBLOG) for providing a "bite" of the history of the "terrible tacos."

The Centers for Disease Control and Prevention (CDC) estimates that each year 76 million – or one out of every four – Americans are sickened as a result of consuming contaminated foods or beverages. Some become seriously ill; 325,000 require hospitalization and 5,000 die. Older adults, young children, and those who have weakened immune systems are particularly vulnerable.
More than 250 different foodborne diseases have been identified. Most of these diseases are infections caused by a variety of bacteria, viruses, and parasites.
Foods that are contaminated with poisonous chemicals or harmful substances can also cause illness. Symptoms of foodborne illness vary by disease but the most common are nausea, vomiting, abdominal cramps, and diarrhea.

About Bill Marler

Bill Marler is an accomplished personal injury and products liability attorney. He began litigating foodborne illness cases in 1993, when he represented Brianne Kiner, the most seriously injured survivor of the Jack in the Box E. coli O157:H7 outbreak.